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General NPI Number Information
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NPI Number | 1629688023
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Entity Type | Individual
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Provider Name | MARCH ELLEN GRAY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 602 TITUS ST STE 120
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City | GILMER
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State | TX
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Zip | 75644-1779
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Country | US
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Telephone | 903-843-5585
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Fax | 903-843-5587
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Provider Business Mailing Address
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Address Line | PO BOX 610393
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City | DALLAS
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State | TX
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Zip | 75261-0393
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Country | US
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Telephone | 903-757-6042
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Fax | 903-232-8226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1010855
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 718744
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License Number State | TX
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